This is an application for a K08 award for Dr. Urmimala Sarkar, a general internist at the University of California, San Francisco, who is establishing herself as a young investigator in ambulatory patient safety among vulnerable chronic disease patients. This K08 award will provide her with the support to accomplish the following goals: (1) to become expert at patient-oriented clinical research in ambulatory safety for vulnerable diabetes patients;(2) to investigate the utility of interactive health information technology for patient safety surveillance and promotion;(3) to implement advanced biostatistical methods in clinical studies;and (4) to apply novel methods such as root cause analysis and the Delphi method;and (5) to develop an independent clinical research career. She has assembled a mentoring team comprised of a primary mentor, Dr. Dean Schillinger, who conducts research in health communication and chronic disease management, and 3 co-mentors: Dr. Robert Wachter, an international expert in the field of patient safety;Dr. Eric Vittinghoff, and expert in study design and biostatistical analysis;and Dr. Mary Blegen, a researcher with expertise in patient safety promotion. Her team also includes 4 scientific advisors: Dr. Wilson Pace, a nationally renowned expert in ambulatory safety surveillance research;Dr. Kaveh Shojania, an expert in evaluation of quality improvement programs and in patient safety research;Dr. Nancy Kupka, an expert in patient safety at the Joint Commission;and Dr. Michael Blum, an expert in HIT. Little is known about the extent, nature, or evolution of adverse events among ambulatory patients, especially among vulnerable groups with chronic diseases. In Aim 1, Dr. Sarkar will leverage an existing, interactive health information technology (HIT) self-management program to monitor safety among 500 diabetes patients. She will employ advance statistical methods to identify patients at highest risk and perform root cause analysis for detected events. In Aim 2, she will investigate the comparative yield for several surveillance mechanisms. In Aim 3, she will use the Delphi method to evaluate the relevance and severity of adverse events that were identified and the feasibility for prevention/amelioration. Public health relevance: Improving our understanding of the nature and etiology of patient safety problems in disadvantaged diabetes patients is critical and can guide future safety assessment and promotion in this high-risk population.